July 27, 2007

Thoughts on Addiction and ADD

A recent cover story in Time Magazine, “How We Get Addicted” from their July 16, 2007 publication, got me thinking about addictions again. Specifically, those with ADHD and addictions. Addictions are common in adults who have ADD, and near-addictions and intermittent substance abuse are more the rule than the exception. This may be because of an inborn physiological problem that makes finding pleasure in ordinary ways much more difficult for the person who has ADD than for the person who doesn’t have it.

It is interesting that brains scans of addicts suggest that they have reduced activity in the prefrontal cortex. People with ADHD also show reduced activity in the prefrontal cortex.

This is the part of the brain that controls rational thoughts that can override impulses. It is unclear whether addiction causes this reduced activity or whether reduced activity, such as you see with ADHD, helps lead to addiction due to low impulse control. In any event, we do know that rates of addiction are significantly higher for those with ADHD than for those without.

Though addiction commonly refers to substance abuse or behavioral addictions like sex and gambling, there are other kinds of non-traditional pseudo-addictions that you might consider “treating” if you have ADD.

Some adults with ADD cannot let go of their sense of unworthiness, behaving as if they were addicted to feeling shame, guilt and unworthiness.

Some adults with ADD are addicted to conflict. Wherever they go, they instigate an argument. They have insight into the problem, but they can’t stop doing it – as if they are addicted to the negative feelings associated with interpersonal conflict.

Some adults with ADD can’t stop procrastinating. No matter how many systems they put into place, they find themselves getting into a frenzy to do things at the last minute. They seem addicted to the pain of the last minute crisis.

For all of these addictions, I ask you to consider these ideas. The first is the power of connection. Human connection, in the form of friendships, memberships, involvement in relationships and groups where you are deeply valued and understood are critical for the person who is trying to overcome an addiction of any kind. Fellowship is the best and safest “drug” we have.

Medications can also help. We have come a long way in our ability to prescribe medications that treat the subtle kinds of desperation, depression and anxiety that can lead to self-medication.

Exercise can help a great deal – it’s one of the best tonics we have for the mind and soul. Aerobic exercise stimulates the production of various chemicals in the brain providing both sensations of pleasure in the brain and increasing focus. Nutritional interventions, such as omega-3 fatty acids help stabilize moods.

I have seen 12-step programs, such as the one used by Alcoholics Anonymous, used with great effect, even for those who are dealing with the less-traditional ADD behaviors that seem like addictions. These programs are not for everybody, but I urge people to think twice before they dismiss a 12-step program. Whether a person suffers from a true addiction – to alcohol, other drugs, food, sex, gambling, shopping, work, exercise or whatever – or behaves as if he were addicted to some of the negative feelings created by symptoms of ADD, he may find that a 12-step program allows him to let go of whatever it is he has been unable to let go of so far.

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Thanks for seeing the connection and sharing your thoughts on addiction. The employee assistance counselor I’ve been seeing asked me just this past week what personal “reward” I was getting from my procrastinating—what causes me to continue this practice despite the problems it causes me at work and at home. It was a question for which I had no good answer, just that I’d always procrastinated (my father proclaimed me a procrastinator at the ripe old age of 9 or 10) and I’m now 54, so I’ve had lots of practice!

I’ve never thought of my procrastination as being an addiction. Nor, for that matter, have I thought of my habit of self deprecation—feeling unworthy--as an addiction. Nor my proclivity to razz (instigate conflict with) my good wife simply to liven things up at home; even after she’s made it clear many times before that she doesn’t find it (whatever I might do to push her button) funny. And certainly not my desire to have sex way more frequently than my wife has ever been interested in. Looking at these traits of mine as addictions or pseudo addictions might allow me make some headway addressing them and changing old habits….errr addictions.

Actually, since my diagnosis (I call it the Great Revelation) a year ago and taking medication, I’ve stopped razzing my wife (well, almost completely) and my desire for sex is more in sync with my wife’s desires, so that’s been good. Having already broken the irons of nicotine addiction by substituting it with another addiction: exercise; and dependence on alcohol by capitalizing on surgery-induced abstinence and the support and fellowship my wife provided to me, I’m now left with these persistent and perplexing traits of procrastination and feeling unworthy and other inattentive ADD traits.

Thanks for sharing your thoughts on this…I’ve been stuck for a while trying to work on this—despite the counselor’s best efforts. It's people like you who help reveal the harlequin mask that is ADD. Considering these traits in this new light should enable me to explore new ideas for relaxing their grip on my thoughts and actions.

First and foremost, Congratulations on the progress YOU have made! Hugs for a fellow adult diagnosis!

I deal with procrastination too (though I have taken the "p word" out of my vocabulary). I tend to set high expectations for myself, then feel horrible for not getting certain things done when I wanted to get them done.

I'm learning to ease up. Make lists. Put things into perspective so you know why you need to do something. To make sure I am successful, I set goals that are big or small. That way I am able to see that there are means to an end. When I complete a task or goal, I remind myself to bask in the accomplishment. Even sometimes pausing a moment to breathe and say "that's done!"

I was diagnosed with ADHD after both my children were, and I realized that I was also "part of the problem." I had self-medicated with caffiene for years, but getting medical treatment has just made a huge difference in all of our lives.
I think, like with all those 12 step programs, it all starts with admitting you have a problem that's not just going to magically go away. Meds don't "solve" ADHD- they just reduce the enertia, and increase the momentum needed to attack problems, in my experience.
I know understand we have certain problems in our family- it doesn't excuse counter-productive behavior, like disorganization, it just helps explain some of it, and gives us the motivation to work a little harder at making it better.

Frustrated! - Are you kidding me? The Dore Center touts this wonderful break through in treating brain complexities and most people have to leave their homes, jobs, and families just to get an idea of one exercise? Do they really want to help people, or just make money? All the information I can get is a "sales pitch" on how wonderful it is...nothing on what it actually is or how it works! My advice...stop paying the money to advertise and start training people to teach it. Get it out there! If it is as good as they say, people will come.
Sorry,
Frustrated!

As a licensed counselor who works with a college and also has a private practice, I specialize in learning disabilities and adhd. I've referred Delivered from Distraction countless times since it was first published. Not only is it a wealth of information that you and Dr. Ratey have compiled, but the positive tone of the book is so affirming to those who have been grappling with the frustrations without ever really recognizing their gifts.I use your "super-turbo-charged engine" analogy a lot, and emphasize that their challenge is simply to figure out how best to harness all that power so they can "take off" and use the gifts that they have including being able to think out of the box and being creative in their own unique way. It's a passion for me to educate and encourage students, parents, and clients. It's fulfilling to help a family or marriage finally identify the piece of the puzzle that has wreaked havoc in their relationships. It's a joy to see their perspective change and to see hurt replaced by understanding. It's exciting to see the individual who has been seen as noncompliant, lazy, or a loser begin to light up and see themselves in a different way and believe in themselves. Thank you for all the wonderful work you and Dr. Ratey do! You are literally changing lives every day, including in Texas! :)

Delivered From Distraction was the book given to me when a counselor- here in TEXAS!- told me I had add & I said no- that can't be me! I am not hyper. Then I read it & said wow- that is my life. Then I gave it to my dad who said the same thing. Thank you to Dr Hallowell & Dr Ratey for writing it & for counselors like yourself who encourage people to read it. It has truly helped me change my life (& it is still a work but better!) & eventually to see the need to get help for my young son :-)

ps- I recently gave a copy to my best friend who was a crystal addict & an alcoholic, who recovered with a 12 step program. She is now a wonderful mother of 3 beautiful children but still struggles with so much and has yet to believe she might have add. She just this week told me she is making an appt with her Dr to discuss it. So thank you again!

attending law school was my dream and now is excruciating-my worst nightmare due to ADD, any tips from other grad/prof students on distractibility and procrastination and severe anxiety in the school setting?

Dr. Hallowell, Since our trip to your place for evaluation...which resulted in a NON add diagnosis, my son Paul, is serving an eight month jail sentence for his 5th dwi...he was in jail three years ago for the same term and violation. I so appreciated your personal comments and your books. But I find myself at a complete loss...I support my son, morally and financially for his legal fees, (he has always paid me back for money I have loaned) He is a talented drywaller but has trouble being consistant...but I feel this is from his alcohol and drug abuse. I am discouraged as Paul is 33 and still not listening to any help that is offered. I thank you for helping all the troubled people you have reached through your work and hope that you never give up!!!

I was reading your blog on addictions and I must say, I never made this connection before. I too never though of procrastination as a source of addition. After reading one of your respondents comments, I made the connection. For years now I have been telling myself that the rush that I get from this procrastination has been a good thing. Subconsciously, I have made a connection to a reward that was terribly destructive. What an AHhHA! moment I just had. Thanks for providing the forum for this type of interaction.

Hello to all!!
i can really relate to this subject. i have had adhd all of my life, but i wasnt diagnosed until i was 28. Because of that i self-medicated myself with drugs and alochol for 2 and half years. and let me tell you it was the worst time of my life. there are so many adults who are undiagnosed and who are going through the same thing as i did. oh yeah.. i am proud to say that i have 12 and half years clean and sober. I cant believe it has been that long.

I have ADHD and a food addiction. I've been treated for bulimia and am purging less, but it still happens much more frequently than I would like. I am a cake decorator, which is a job I love and am really good at, yet I cannot stop eating my ingredients! I've tried over and over to control my weight and diet and I fail every time. I'm so discouraged that I just don't know where else to turn. Should I give up my job? Anybody, please help!

Dr. Hallowell and friends:
I have read both "Driven..." and "Delivered..." and they are helpful to me as an unyet diagnosed, but likely, ADD person. I would not say I have addiction issues so much as that I self-medicate with alcohol and sleeping pills to quiet my mind and relax and sleep.

I wonder if you can provide any information on co-occurrence of ADD with borderline personality disorder. That is my current diagnosis, after over 15 wholly ineffective years (I'm a 44 year old female) of therapy (including DBT) and medication for various types of depression and anxiety. I have had great difficulty finding information about how these two conditions affect one another.

I was a hyperactive child but always did well in school and college and on standardized tests. I think the very supportive and structured private school environments I was in helped me succeed. As an adult, however, I have never been able to keep a job longer than three years (often due to bad luck, i.e. layoffs), cannot seem to sustain a relationship, and in the past few years have lost the ability to manage money. I am an intelligent and creative person (I have a Master in Fine Arts degree) but have gotten to the point where I can't even bear to look for a new job after so many rejections and failures. I don't do well in an 8-5 office setting, mostly because I need to move around a lot during the day. I also believe working on a computer worsens my ADD tendencies.

I've been a "night owl" and suffered from insomnia since I was a child. That also makes finding a steady job hard. I NEVER wake up feeling rested, and after a few weeks or months of an 8-5 schedule, such as for a temp job, I can do little more than come home and get in bed at 6 pm. Then depression and guilt and self-loathing set in, because I feel like I'm doing nothing worthwhile.

I applied for SSDI in December but have no decision yet. I am hoping to do a STEPPS program soon. I wonder if you might have any other recommendations?

The biggest advantage to AA is that it is free. The only criteria you to enter their doors is the desire to quit drinking.

The are many overwhelming aspects to this area.

AA has a tendency to over emphasize higher-power/God. And many do not like that.

The other knock on AA is that they seem to gravitate only to the 12 steps and the Big Book, that were written in the mid 30's. Thus ignoring any of the large strides we have made in this area in the last 30 years.

But

It is free.

It is with people.

It is a place that is available and that someone can go to, instead of going to a bar. Going to a bar is a bad habit. But, it is a habit. The best way to defeat a bad habit, is to work on a better habit. The Universe hates a void.

I just saw your interview on fox 25. what insurances do you accept,if any.I am a 32 yr old male with a three year old daughter. Every career I have persued I have excelled in as far as i could go just shy of having to obtain a dgree or any type of classroom style education.I was diagnosed w/ add after being thrown out of two high schools. My parents constantly went after the school board to have myself take a core exam.Not until my junior year did the school system finally comply and found I had add. Thier findings labeled me as very intelligent with a very short attention span.after being injured on the job in2008 I am nop longer able to do physical laborand found myself either having to go back to college or obtain a minimum wage job. It's seems to be a shame to waste my potential pushing a broom. If there is any information you could give me It would be greatly appreciated. Thank You for your time.